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Complications associated with combined direct and indirect bypass in Moyamoya Disease: A meta-analysis
Sávio Batista1, Stefan Koester2, Anthony E Bishay2
1School of Medicine, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Cidade Universitária, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-590, Brazil.
Abstract:
Bypass revascularization helps prevent complications in Moyamoya Disease (MMD). To systematically review complications associated with combined direct and indirect (CB) bypass in MMD and analyze differences between the adult and pediatric populations. A systematic literature review was conducted per PRISMA guidelines. PUBMED, Cochrane Library, Web of Science, and CINAHL, were queried from January 1980 to March 2022. Complications were defined as any event in the immediate post-surgical period of a minimum 3 months follow-up. Exclusion criteria included lack of surgical complication reports, non-English articles, and CB unspecified or reported separately. 18 final studies were included of 1580 procured. 1151 patients (per study range = 10-150, mean = 63.9) were analyzed. 9 (50.0%) studies included pediatric patients. There were 32 total hemorrhagic, 74 total ischemic and 16 total seizure complications, resulting in a rate of 0.04 (95% CI 0.03, 0.06), 0.7 (95% CI 0.04, 0.10) and 0.03 (95% CI 0.02, 0.05), respectively. The rate of hemorrhagic complications in the pediatric showed no significant difference from the adult subgroup (0.03 (95% CI 0.01-0.08) vs. 0.06 (95% CI 0.04-0.10, p = 0.19), such as the rate of ischemic complications (0.12 (95% CI 0.07-0.23) vs. 0.09 (95% CI 0.05-0.14, p = 0.40). Ischemia is the most common complication in CB for MMD. Pediatric patients had similar hemorrhagic and ischemic complication rates compared to adults.
Insights
Combined bypass surgery for Moyamoya Disease (MMD) has similar complication rates in pediatric and adult patients. Ischemia is the most frequent complication following this MMD treatment.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Moyamoya Disease (MMD) management often involves bypass revascularization to prevent stroke.
- Combined direct and indirect (CB) bypass is a surgical technique used in MMD.
- Understanding complications associated with CB bypass is crucial for patient outcomes.
Approach:
- Conducted a systematic literature review following PRISMA guidelines.
- Searched major databases (PubMed, Cochrane, Web of Science, CINAHL) from 1980 to 2022.
- Analyzed complication data from 18 studies encompassing 1151 patients, including pediatric and adult subgroups.
Key Points:
- Ischemia was the most common complication following CB bypass for MMD.
- Hemorrhagic complication rates did not significantly differ between pediatric and adult MMD patients (0.03 vs. 0.06).
- Ischemic complication rates were also similar in pediatric and adult MMD patients (0.12 vs. 0.09).
Conclusions:
- Combined bypass (CB) surgery for Moyamoya Disease (MMD) is associated with notable complication rates, primarily ischemia.
- Pediatric and adult populations exhibit comparable rates of hemorrhagic and ischemic complications following CB bypass.
- These findings aid in risk assessment and patient counseling for MMD surgical interventions.
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